REWARD: 2,000PHP

Minimum Qualification(s):

• Minimum of 2 years’ experience in submitting claims to insurance provider (Medicaid, Medicare and commercial insurances)

• Above average communication skills

  Claims Processor

Summary:

We are seeking a detail-oriented and organized Claims Processor to manage the submission of healthcare insurance claims for a Durable Medical Equipment (DME) company. This role focuses on ensuring timely and accurate claim submissions to insurance providers and following up on claim status to secure reimbursements. The ideal candidate has a solid understanding of healthcare billing, insurance policies, and DME coding.

Job Description:

• Submit insurance claims (electronic and paper) for DME products to commercial, Medicaid, and Medicare payers.

• Review patient information, physician orders, and insurance eligibility to ensure accurate claim preparation.

• Verify medical necessity documentation (CMNs, prescriptions, progress notes) for compliance.

• Ensure proper use of HCPCS, ICD-10, and modifiers per payer requirements.

• Monitor and track claims to confirm successful transmission and receipt by insurance providers.

• Identify and correct claim rejections or denials; resubmit claims as needed.

• Follow up on unpaid or underpaid claims in a timely manner.

• Communicate with insurance companies and providers to resolve issues or obtain additional documentation.

• Maintain up-to-date knowledge of payer-specific guidelines and policy changes.

• Collaborate with billing and customer service teams to resolve claim-related inquiries

Other information:

• Salary is between 27,000PHP - 30,000PHP

• Work-from-home with 15 days on-site per year

• Night shift (Eastern Standard Time)